Development of a pulsatile cadaver-based simulation for training of open abdominal vascular surgery skills

Objective: Developing competence in open aortic surgery is increasingly challenging in vascular surgery training programs. Although static cadaver models provide an opportunity for dissection and exposure, the lack of pulsatility limits further education in managing blood vessels. We developed an affordable pulsatile cadaver simulation model to improve training in open abdominal aortic surgery with the primary objective of determining whether it incorporated the fidelity required to teach critical surgical techniques. Methods: The University of Minnesota Bequest program supported a pilot project to develop a fresh pulsatile cadaver. A written pretest on exposure of the aorta in various locations was given to all trainees. The external iliac artery was exposed, cannulated, then perfused in a pulsatile fashion using normal saline and a pump. Trainees were then evaluated and timed on location of the aorta, retractor placement, dissection, and creation of an aortic anastomosis. Results: Twenty-six pulsatile cadaver procedures were performed with five fellows over 13 months. All procedures were performed under the supervision of the same faculty member. Total cost over the study period was $8800. Four abdominal aortic aneurysms were found (15%). With bilateral iliac artery ligation, adequate pulsatility was created for blind supraceliac aortic dissection. Abdominal wall and organ relationships were ideal for teaching proper retractor placement and techniques for vascular dissection, endarterectomy, and anastomosis. Although 100% of fellows documented written understanding of the steps for procedures on the pretest, no fellow successfully placed a supraceliac aortic clamp, properly positioned retractors for proper open AAA exposure, or placed all proximal aortic back wall sutures transmurally on the initial assessment. After training for a variable number of cases, all were able to place a supraceliac clamp blindly within 4 minutes from skin incision. Retractor placement and suturing technique improved significantly for all trainees during the study period. Conclusions: The implementation of a pulsatile cadaver-based simulation model for abdominal vascular surgery has the potential to be both affordable and provide necessary haptics and fidelity for training fellows in critical abdominal vascular techniques.